头皮针治疗后急性缺血性脑卒中患者脑血流及肢体运动功能的变化

Changes of cerebral blood flow and limb motor function in patients with acute ischemic stroke after scalp acupuncture treatement

目的:观察急性缺血性脑卒中患者经头皮针治疗对脑血流变化与肢体运功功能恢复的影响,并与未经头皮针治疗急性缺血性脑卒中患者比较。方法:选择1994-01/2002-01在广州市第六人民医院神经康复科住院的缺血性脑卒中患者60例,随机分为治疗组30例和对照组30例,治疗组在起病3d内施以头皮针治疗,取病灶侧百会透曲鬓、颞三针、头双针等,以28号5.00～6.67cm(1.5～2.0寸)不锈钢毫针沿头皮15°～30°斜刺至帽状腱膜下,然后使针与头皮平行继续捻转进针,深度30mm左右再运针,运针时头针的捻转速度一般为150～250次/min,得气后留针。留针一两个小时,每10分钟行针一次,2次/d,10d为1个疗程。其他常规治疗两组相同。两组患者于治疗前24h及治疗后10d评定肢体运动功能采用Fugl-Meyer运功功能积分法(上肢33项,下肢17项,各项最高分为2分,总分100分),病灶侧大脑中动脉的平均血流速度变化采用经颅多普勒超声探测。结果:60例患者全部进入结果分析。①Fugl-Meyer运功功能积分:治疗后,两组患者肢体运动功能积分均有提高,治疗组患者在Fugl-Meyer上、下肢评分均高于对照组犤(44.57±3.28)分,(21.51±3.61)分;(26.23±7.25)分,(15.86±6.27)分,(t=6.87,6.02,P<0.01)犦。②大脑中动脉的平均血流速度:治疗组治疗后高于对照组犤(88.46±9.68)cm/s,(65.22±11.20)cm/s,(t=6.25,P<0.01)犦。结论:早期头皮针治疗使急性缺血性脑卒中患者脑血流加快,改善大脑局部血液循环,从而促进运动功能恢复,使运动功能积分提高。

AIM： To observe the effect of scalp acupuncture treatment on the changes of cerebral blood flow and the recovery of limb motor function in patients with acute ischemic stroke, and compare with the patients with acute ischemic stroke without scalp acupuncture treatment. METHODS： Sixty inpatients with acute ischemic stroke from Department of Psychiatry and Rehabilitation of Guangzhou Sixth People＇s Hospital were selected from January 1994 to January 2002, and divided randomly into treatment group with 30 cases and control group with 30 cases. The patients in treatment group were treated with scalp acupuncture treatment at the onset of illness in 3 days. Paihui （Du20） was gained on the injured side. Ch＇upin （GB7） was penetrated and on temple with three needles and scalp with double acupuncture etc. Using No.28, 5.00-6.67cm （1.5-2.0 inch） stainless steel filifonn needle, 15-30°along skin of scalp punctured under the cap-like aponeurosis, and then made needle and scalp parallel to continue twist the needle. At about 30 mm, the needle moved again, at a speed of 150-250 times per minute. After deqi, needling sensation, the needle was stayed for one or two hours, needle transmission once per 10 minutes, twice per day and 10 days as a course. Other routine treatment was the same between the two groups. Extremity motor function was evaluated by Fugl-Meyer motor function integral method in the two groups 24 hours before treatment and 10 days after treatment （upper limb： 33 terms, lower limb： 17 terms; the highest mark of each term was 2 points, and full mark was 100 points）. The change of average flow velocity in middle cerebral artery in the injured side was detected by transcranial Doppler （TCD）. RESULTS： Totally 60 patients were involved in the result analysis. ① Fugl-Meyer motor function integral： After treatment,scores on limb motor function were both increased in the two groups. It was higher in treatment group on Fugl-Meyer upper and lower limb evaluation than that in control group [（44.57±3.28）, （ 21.51±3.61 ） ; （ 26.23±7.25 ）, （ 15.86±6.27 ）, （t=6.87, 6.02, P 〈 0.01）]. ② The average flow velocity in the middle cerebral artery： After treatment, it was higher in treatment group than that in control group [（88.46±9.68）, （65.22±11.20） cm/s, （t=6.25, P 〈 0.01）]. CONCLUSION： In earlier period scalp acupuncture treatment can speed up the cerebral flow velocity in patients with acute ischemie stroke and ameIiorate the local blood circulation so as to improve the recovery of motor function and increase the integral of motor function.